The U.S. Drug Enforcement Agency is tasked with classifying certain prescription drugs under the Controlled Substances Act. Certain healthcare providers, such as pharmacies and hospitals can be licensed to distribute one or more of the classes of controlled substances to patients. While these healthcare providers are permitted to dispense certain classes of controlled substances, failure to properly dispense these controlled substances for a proper purpose can result in a healthcare provider's controlled substance license being revoked. Without a controlled substance license, most pharmacies and hospitals would not be able to operate effectively.
For small single-unit pharmacies and hospitals, the amount of prescription activity is not likely to be such that the owners or managers could not effectively monitor the level and frequency at which different classes of controlled substances are being prescribed. As such, when changes in prescription behavior or frequency occur, these owners or managers will likely be aware of the reasons for the change and can address it accordingly to make sure fraudulent activity is not occurring.
However, when the pharmacy or hospital is part of a chain or one of many owned by an ownership entity, it can be difficult or impossible for the ownership entity to fully monitor, in real-time, the controlled substance prescription trends for each individual pharmacy or hospital. Instead, the ownership entity must rely on the local management to properly monitor for potential fraud in the distribution of controlled substances. However, if the local management fails to properly monitor or is aware of and fails to correct any fraudulent activity related to the distribution of certain classes of controlled substances, the end result will likely be the pharmacy or hospital losing its controlled substance license and the chain or ownership entity closing the pharmacy or hospital.
The ability to monitor distribution trends for classes of controlled substances in real-time or near real-time at the healthcare provider level and comparing those trends to historical baselines for each distinct healthcare provider will allow an owner of a healthcare provider to quickly see when current trends related to prescribing controlled substances on the whole or at the class level exceed normal threshold levels and can immediately investigate the prescription habits of the particular healthcare provider to determine if any issues exist that may put its controlled substance license at risk.